|A Service Audit on Patient Flow from Tallaght University Hospital to Respiratory Unit Peamount Healthcare
|E Cribbin, A Kurian, A Bradley, B MacNamara, C Slattery, C Lynch, Professor E Moloney, K Anyakudo, M Fitzgerald, Professor S Lane, Dr Kooblall
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|General Respiratory and Sleep
|Peamount Healthcare Respiratory Unit offers inpatient rehabilitation for respiratory patients requiring ongoing intervention following their acute stay in Tallaght University Hospital (TUH). In 2019, the bed occupancy for the unit was 76%. The purpose of this audit was to review timelines of patient flow from TUH to the unit to identify ways of improving efficiency of transfer and maximising bed capacity.
A nine week service audit was carried out identifying the number of referrals to the unit, timelines for processing of referrals and subsequent transfer of patients, and to identify delays in this process.
Over the 9 week period, 27 patients were referred to the unit, 18 of which were subsequently transferred. The time from receipt to review of referral was 0.6 days, from review to acceptance 0.81 days, and from acceptance to admission to the unit 0.4 days. Additional medical information was requested for 34% of referrals received in order for a decision to be made on suitability for admission of the patient to the unit. 22% of referrals were declined however this was as a result of admission restrictions on the unit related to aerosol generating procedures due to COVID 19. On average, 3 (range 1-10) communications between Peamount and TUH were required during this process from receiving the referral to the patient being accepted and/or admitted (excluding standard communications such as sending of swab results, transfer letter and nursing handover). Delay in transfer because of bed capacity in Peamount Healthcare was 3 days in total over the 9 week period.
The results overall are indicative of efficient flow between TUH and the respiratory unit Peamount Healthcare. Improvements could be made however in ensuring all relevant information is being sent on initial referral to minimise the number of communications and resulting delay in patients being accepted to the unit. Several quality improvement initiatives have been identified as a result of this audit including;
• A review of the referral form and formulation of a checklist to prompt referrers in TUH of appropriate information to be included on the referral
• Establishment of a morning huddle between sites to allow for a single forum for all information to be communicated regarding referrals and transfers
• Utilisation of the patient board on the unit to display predicted discharge dates allowing us to predict bed availability for TUH
• Development of a Standard Operating Procedure to streamline process of referrals and transfer inclusive of key performance indicators
Data collection and quality improvement projects are ongoing aiming to maximise bed capacity and improve respiratory care pathways between the acute and sub-acute hospital sector.